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t-UR OFFICE USE: --------- .: APPLICATION fOR 5ANITATION PERMIT <• Permit No. ._.. Fl 2`�_� : ----------------- ----------------- ------------`-'------ (Complete in Duplicate) ----------- ----------------- ----------- This Permit Ex ires 1 Year From Date Issued Date Issued _9,l�,1e1______ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instali the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS At f)1 OC TION------------- "_ � = - -- ------ Owner's Name------- t - } - Phone-------------------------------- - -------Address-- e ---- - - i9 - ------------------------------------------ Contractor's Name_.---- Phone..__.._.-_.. --------------- ------------------------•--- Installation will serve: Residence "Apartment ❑ Commercial Trailer Cour# r ++ �t l ❑ O ❑ (Motel ❑ Other ❑ Number of living units: _!___._ Numb�of bedrooms,_._ Number of baths -_-t�-_ Lot size '_--- . ------------- Water Supply: Public sNstem ommunity system ❑ Private ❑ Depth to Water Table is Character of soil to a deptl, of 3 feet: Safid ❑ Gxayel-❑--Sandy Loam ❑ GIay.Loam ❑ Clay _dobe ardpan ❑ _.. _ Previous Application Madel (If yes,date_. _.� _j No New Construction: Yes ❑ N FHA/VA: Yes ❑ No TYPE OF INSTALLATIO IIAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest vwelL-_____-__-_.---Distance'from foundation---------------- Material.--__.-....,______.___-__..__________ - ` - -- ---- a D1fS �� f compar'menu Y , ---------.-.Size--------------------------------Liquid depth------ ---- ------------- Capacity---------------------- D;sposaJ Field: Distance from nearest well... ---------Distance from foundation__ --4-----------Distance to nearest lot line_-- -�__... ❑ l*- umber of lines---------- __ `f-_. Length of each line------- , '/ p -- - - -------.Width of trench ---<-D y ------------ ype of filter material__---)/ De th of filter materiai__�� g -�-- ----- -----------Tota! length ---- _ ------------------------- V p '____ _--_--.Distance . om foundation_ a___1__.___Distance to nearest lot line__'S-_/_- Seepage;WPi ,��DistanceNeof nits restiwel----- Lining material_JrVz ....Size: Diameter_----_�:�9 De th___- � I ,� �. ---- p �- �--- d / Cesspool: Distance from nearest wefh_---___..._-_-_Distance from foundation ----_----Liningmaterial______-___-____________-___.__- ---- -----Size: Diameter_:..__.^-' - �� ----- ----Depth---------------------------------------------------Liqu;�C apacify---------- - -- --------gals. Privy: Distance from nearest waif -------------------------------------------------Disfance from nearest buildin ❑ Distance to nearest lot line'------------------------------------------------ ----------- Remodeling and/or repairing (descrbe): _ I �i _ -. _--J_ - - ----------•-- - ---------------- ----•----------------------- ---------------I------------------------------- ----- � I., --------------------------------- •--------------------------- ---------- --------------- ---- ----------------------- --------------------------------------------------------------------------i-----—------------------------------------------—-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StateAinand rules an gulations of the San Joaquin Local Health District. (Signed)_ ------- - = Owner an ontractor) f By:---- --- ------------ --- ----- Title �- - or C (Title) - -- r(Piot plan, showing si o of, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED,BY------ --1�~ ---------------- ------ DATE - -------------------------------------------------------- - - - ------- ---------------------- REVIEWED BY.. ------- DATE ---------- UILDING PERMIT ISSUED------------- ------ ----------- —-------------------- -- --- --------- DATE ---------------------------- - - --Alterations ------------------ and/or recommendatiorks ------ ---- -------------------------------------------- ------------------------------------ -----•----- -----: --------- ----------- ----------- ------ ---------------------------------- ------------------- FINAL INSPECTION BY:------------ t_.____ � Date-... - --------------------------------- "SAN J.OAQUIN'LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak.Street f 124 Sycamore StreeT ' 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California s� F.P.r-O.